By Elizabeth Hoffman
Elizabeth joins Fertility Insights as our correspondent on young women’s fertility. Elizabeth recently graduated from Dartmouth College, where she studied women’s health and also volunteered as a sexual health advocate. Her contributions to Fertility Insights will reflect the perspective of young women who may not want to become pregnant now, but wish to preserve future fertility options.
March was Endometriosis Awareness Month, and given the worldwide success of EndoMarch, the efforts to educate on this disease have been impressive.
As someone craves information on female reproductive health, I was happily surprised by how informative the awareness campaigns were. Given that many of my peers have never heard of the disease, and that it is a leading cause of infertility, I would like to share the information on endometriosis I find most pressing in hopes that education will contribute to better diagnosis and care.
- Endometriosis is correlated with female infertility. Of the millions of women around the world who are unsuccessful in becoming pregnant after one year of unprotected sex, 25-50% have endometriosis. Conversely, 30-50% of endometriosis patients experience infertility. These data indicate a strong correlation between endometriosis and infertility.
- Endometriosis is also a common disease. According the American College of Obstetricians and Gynecologists, endometriosis affects about 10% of reproductive age women.
- It can cause extraordinary pain. Endometriosis is defined as the migration of endometrial cells—the tissue that females shed during menstruation—migrating from the uterus into the pelvic cavity. This migration can result in cysts and adhesions on the ovaries, fallopian tubes, outside of the uterus, and other tissues including the large intestine. Unlike normal endometrial tissue, it is trapped in the pelvic cavity without a way to exit the body, and it continues to respond to menstrual hormones, causing severe pain for many patients. The pain of this disease can be so severe that some women elect to have hysterectomies.
- Endometriosis diagnosis is often very delayed. According to EndoMarch organizers Million Women March, it takes between 6 and 10 years for most patients to receive an accurate diagnosis after the symptoms present. In 2006, Fertility and Sterility, a leading publication on reproduction, published a study on why there is such a significant delay in diagnosis. The researchers found a median delay of 102 months before diagnosis, with common factors for delay including doctors dismissing patient pain, hormonal suppression of symptoms (i.e. oral contraceptives) and imprecise diagnostic tools.
- The only effective diagnostic tool is laparoscopy. Laparoscopy is a minimally invasive surgery that enables a physician to examine your internal organs. Currently there is no reliable imaging, blood or urine test that can diagnose endometriosis. Recently though, a leading researcher in the field from the Yale School of Medicine, Dr. Hugh Taylor, identified a genetic mutation that was associated with up to a third of endometriosis patients. Hopefully better, noninvasive diagnostic tools will result from ongoing research.
If you experience intense cramping during your periods, pain during intercourse, urination or bowel movements, you should speak with your gynecologist about these symptoms and ask about endometriosis. As Ronny wrote in Fertility Insights last, your pain is not imaginary and deserves respectful consideration by your care provider.